[Model of care for the treatment of patients with osteoarthritis from the first to the third level]. / Modelo de atención para el tratamiento de pacientes con osteoartritis del primer al tercer nivel.

INTRODUCTION: Osteoarthritis in Mexico is one of the ten most frequent causes of disability. Early diagnosis and detection of risk factors are determinant for treatment. The institutional organization establishes therapeutic guidelines according to each level of care, but effective management is not achieved. MATERIAL AND METHODS: A prospective, pilot, interventional, clinical study was conducted, which included patients diagnosed with different degrees of knee osteoarthritis in the first, second and third level of care, with an integrative model that includes a group of professionals for the intervention of nutritional, physiotherapeutic, social and psychological evaluation from the first level. RESULTS: The intervention of a multidisciplinary care group allows a correct evaluation and assignment of the level of care, optimizing human and material resources. The participation of different disciplines in nutrition, psychology, social work, physiotherapy and rehabilitation modifies the global lifestyle by involving the patients themselves in their treatment. The intervention group had improvements in the visual analog pain scale, mobility arcs, low body mass index and improvement in the psychological aspect. CONCLUSIONS: The proposed model of care demonstrates that implementation in the institution and in each clinical care unit should be considered to improve outcomes.

INTRODUCCIÓN: La osteoartritis en México es una de las 10 causas más frecuentes de discapacidad. El diagnóstico temprano y la detección de factores de riesgo son determinantes para el tratamiento. La organización institucional establece las pautas terapéuticas de acuerdo con cada nivel de atención, pero no se logra un manejo efectivo. MATERIAL Y MÉTODOS: Se realizó un estudio prospectivo, piloto, de intervención, clínico conformado por pacientes diagnosticados con diferentes grados de osteoartritis de rodilla en el primer, segundo y tercer nivel de atención, con un modelo integrador que incluyó un grupo de profesionales para la intervención de la evaluación nutricional, fisioterapéutica, social y sicológica desde el primer nivel. RESULTADOS: La intervención de un grupo de atención multidisciplinaria permite una correcta evaluación y asignación del nivel de atención optimizando los recursos humanos y materiales. La participación de diferentes disciplinas en nutrición, sicología, trabajo social, fisioterapia y rehabilitación modifica el estilo de vida global al involucrar a los propios pacientes en su tratamiento. El grupo de intervención tuvo mejoras en la escala de dolor análogo visual, arcos de movilidad, bajo índice de masa corporal y mejoría en el aspecto sicológico. CONCLUSIONES: El modelo de atención propuesto demuestra que la implementación en la institución y en cada unidad clínica de atención debe considerarse para mejorar los resultados.

Rescue of Discarded Grafts for Liver Transplantation by Ex Vivo Subnormothermic and Normothermic Oxygenated Machine Perfusion: First Experience in Spain.

BACKGROUND: Ex vivo machine perfusion (MP) has been reported as a possibly method to rescue discarded organs. The main aim of this study was to report an initial experience in Spain using MP for the rescue of severely marginal discarded liver grafts, and to, secondarily, define markers of viability to test the potential applicability of these devices for the real increase in the organ donor pool. METHODS: The study began in January 2016. Discarded grafts were included in a research protocol that consisted of standard retrieval followed by 10 hours of cold ischemia. Next, either normothermic (NMP) or controlled subnormothermic (subNMP) rewarming was chosen randomly. Continuous measurements of portal-arterial pressure and resistance were screened. Lactate, pH, and bicarbonate were measured every 30 minutes. The perfusion period was 6 hours, after which the graft was discarded and evaluated as potentially usable, but never implanted. Biopsies of the donor and at 2, 4, and 6 hours after ex vivo MP were obtained. RESULTS: A total of 4 grafts were included in the protocol. The first 2 grafts were perfused by NMP and grafts 3 and 4 by subNMP. The second and third grafts showed a clear trend toward optimal recovery and may have been used. Lactate dropped to levels below 2.5 mmol/L with stable arterial and portal pressure and resistance. Clear biliary output started during MP. Biopsies showed an improvement of liver architecture with reduced inflammation at the end of the perfusion. CONCLUSION: This preliminary experience has demonstrated the potential of MP devices for the rescue of severely marginal liver grafts. Lactate and biliary output were useful for viability testing of the grafts. The utility of NMP or subNMP protocols requires further research.

"Super-rapid" Technique in Donation After Circulatory Death Liver Donors: Advantages and Disadvantages.

In recent years, donation after circulatory death (DCD) has increased as an option to overcome the organ donor shortage crisis and to decrease the large number of patients on liver transplant waiting lists. The "super-rapid" technique is now the "gold standard" procurement method because of its availability, reproducibility, low cost, and extensive experience. Recently, extracorporeal support has been implemented, with encouraging results. Strict donor acceptance criteria have proven to be essential to optimize the DCD liver graft outcomes and minimize biliary complication rates. In this study we assessed the state of the art of DCD liver transplantation with regard to its development and the actual strategies to prevent graft complications, with aim of expanding the pool of marginal liver donors.

Síndrome de Poland: descripción de un caso en la sala de partos / Poland syndrome: Description of a case in the delivery room

El Síndrome de Poland es un trastorno congénito raro que se caracteriza por la ausencia o hipoplasia unilateral del musculo pectoral mayor asociado a malformaciones en la extremidad superior y tejido mamario ipsilateral. Las manifestaciones clínicas en los recién nacidos solamente se describen en la literatura, por lo tanto muchos aspectos de su presentación en las guarderías son ignoradas. Presentamos el caso de un recién nacido que manifiesta una respiración paradójica desde el momento del nacimiento. Este tipo de hallazgo clínico esta vagamente descrito en el Síndrome de Poland y menos aún en el periodo neonatal.

Poland Syndrome is a rare congenital condition characterized by the absence unilateral pectoralis major muscle. it can be associated with other multiple malformations usually in the same affected side. The clinical manifestation in newborns are merely described in the literature, therefore many aspect in its presentation in the nursery are ignored. We present the case of a newborn manifesting paradoxical breathing since birth. This clinical finding is barely describe in poland's syndrome and even less during newborn period.

Asociación de absceso cerebral y malformación arteriovenosa pulmonar / Brain abscess and pulmonary arteriovenous malformation

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Synthesis, characterization and Pd(ii)-coordination chemistry of the ligand tris(quinolin-8-yl)phosphite. Application in the catalytic aerobic oxidation of amines.

The synthesis and characterization of the ligand tris(quinolin-8-yl)phosphite, (P(Oquin)3), are described and its coordination chemistry toward the metal precursor [Pd(COD)Cl2] (COD = 1,5-cyclooctadiene, C8H12) is reported. A new Pd(ii)-P(Oquin)3 metal complex was isolated and fully characterized ([Pd{P(Oquin)3}Cl2]), and its X-ray diffraction analysis shows that the phosphite ligand coordinates as a bidentate P-N chelate. This complex is an efficient catalyst for the solvent-free mild oxidative coupling of primary amines to imines using air as an oxidant, obtaining moderate to good yields (up to 99%) and turnover numbers (TONs up to 230). This catalyst can be recovered from the reaction mixture and reused in a subsequent run without a significant loss of activity. Kinetic measurements of the oxidation of benzylamine suggest that the rate law is r = kapp[BnNH2][cat] ([BnNH2] = molar concentration of benzylamine, [cat] = molar concentration of [Pd{P(Oquin)3}Cl2], kapp = k[O2]c = 0.756 L mol-1 h-1 = apparent rate constant). In situ NMR tests were performed to gain some insight into the reactivity of the Pd(ii)-P(Oquin)3 complex toward benzylamine.

Seroprevalencia y factores de riesgo asociados a infección por Trypanosoma cruzi y Toxoplasma gondii en la comunidad Saimadoyi, Sierra de Perijá, estado Zulia / Seroprevalence and risk factors associated to infection by Trypanosoma cruzi and Toxoplasma gondii in the Saimadoyi community, Sierra de Perija, Zulia state

La enfermedad de Chagas y la toxoplasmosis constituyen problemas de salud característicos de zonas rurales. El objetivo de esta investigación fue determinar la seroprevalencia de Trypanosoma cruzi y Toxoplasma gondii en la comunidad Saimadoyi. Se estudiaron 166 muestras de sueros de individuos de ambos sexos (100 femeninos y 66 masculinos) con edades comprendidas entre 1 a 83 años. La determinación de anticuerpos se realizó a través de la técnica de ELISA, utilizando kits disponibles comercialmente. La seroprevalencia de Trypanosomacruzi fue de 51% (87/166), mientras que para Toxoplasma gondii fue de 57% (95/166). La mayoría de casos positivos se encontraron en los individuos menores de 20 años, sin embargo, no se encontraron diferencias significativas con respecto al género o grupo de edad para ambas parasitosis. Los datos epidemiológicos mostraron que los factores de riesgo estadísticamente significativos (p<0,05) para la infección por T. cruzi fueron el tipo de vivienda, contacto con perros o chipos y contaminación del suelo con heces; mientras que para la infección por T. gondii, el contacto con gatos y la higiene inadecuada fueron los riesgos significativos. El elevado número de casos seropositivos en mujeres en edad reproductiva sugiere la transmisión vertical de ambos parásitos.

Chagas disease and toxoplasmosis are health problems characteristic of rural areas. The aim of this research was to determine the seroprevalence of Trypanosoma cruzi y Toxoplasma gondii. in community Saimadoyi. 166 serum samples from individuals of both sexes (100 female 66 male and) aged 1-83 years were studied. The determination of antibodies was performed by ELISA using a commercial kit. Trypanosoma cruzi seroprevalence was 51% (87/166), while for Toxoplasma gondii was 57% (95/166). Most positive cases were found in people under 20 years old, however no significant differences with regard to gender or age group for both parasites were found. Epidemiological data showed statistically significant risk factors (p <0.05) for T. cruzi infection were the type of housing, contact with dogs or chipos and soil contamination with feces; while for T. gondii infection, contact with cats and poor hygiene were the significant risks. The high number of seropositives cases in women of reproductive age suggests vertical transmission of both parasites.

SECOND LATIN AMERICAN INTERCOMPARISON ON INTERNAL DOSE ASSESSMENT.

Internal dosimetry intercomparisons are essential for the verification of applied models and the consistency of results'. To that aim, the First Regional Intercomparison was organised in 2005, and that results led to the Second Regional Intercomparison Exercise in 2013, which was organised in the frame of the RLA 9/066 and coordinated by Autoridad Regulatoria Nuclear of Argentina. Four simulated cases covering intakes of (131)I, (137)Cs and Tritium were proposed. Ninteen centres from thirteen different countries participated in this exercise. This paper analyses the participants' results in this second exercise in order to test their skills and acquired knowledge, particularly in the application of the IDEAS Guidelines. It is important to highlight the increased number of countries that participated in this exercise compared with the first one and, furthermore, the improvement in the overall performance. The impact of the International Atomic Energy Agency (IAEA) Projects since 2003 has led to a significant enhancement of internal dosimetry capabilities that strengthen the radiation protection of workers.

Carcinoid tumor of the common bile duct / Tumor carcinoide del conducto biliar común

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Causa rara de hipertensión arterial en la juventud: paraganglioma retroperitoneal con invasión vascular / An uncommon cause of high blood pressure in young people: retroperitoneal paraganglioma with vascular invasion

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Biliary complications after liver transplantation using side-to-side choledochocholedochostomy reconstruction with or without T-tube.

BACKGROUND: Biliary complications are a frequent cause of morbidity, graft loss, and death after orthotopic liver transplantation (OLT). The choledochocholedochostomy anastomosis without a T-tube is controversial, as it has been related to more biliary complications. AIMS: The aims of this study were to determine the incidence and to identify the risk factors of post-OLT biliary complications after reconstruction with or without a T-tube. MATERIALS AND METHODS: Ninety-five consecutive adult patients with deceased donor liver transplantations (overall survival rate, 86.3%; mean follow-up, 22.2 months) were analyzed to determine the incidence and type of biliary complications in 2 groups: choledochocholedochostomy with (45 patients, Group I) or without a T-tube (50 patients, Group II). The incidence of biliary complications in Groups I and II was 40% (18/45) and 30% (15/50), respectively (P > .05). In Group I, 49% of the complications were directly related to the T-tube. Biliary anastomosis stricture was more frequent in Group II (28% vs 8.9% in Group I; P = .018). Endoscopic retrograde cholangiopancreatography (ERCP) was the most common therapeutic procedure for the resolution of biliary complications in both groups (Group I, 66.5%; Group II, 58.2%). Arterial thrombosis, high pretransplantation Model for End-Stage Liver Disease (MELD) score, and donor obesity were identified as risk factors for biliary complications after OLT. CONCLUSION: OLT biliary reconstruction without a T-tube is not related to an increased risk of biliary complications, although stricutre of the anastomosis is more frequent in this group of patients. Donor obesity, arterial thrombosis, and high pretransplantation MELD score are associated with a higher incidence of biliary complications after OLT.

Aislamiento y caracterización de los metabolitos secundarios mayoritarios de los extractos de cloroformo y cloroformo: metanol(8:2) de hojas de cnidoscolus chayamansa / Isolation and characterization of the major secondary metabolites of the chloroform and chloroform: methanol (8: 2) extracts of cnidoscolus chayamansa leaves

El estudio de los productos naturales ha adquirido gran importancia en los últimos tiempos. Se ha comprobado que algunos de los compuestos encontrados en plantas naturales poseen una mayor actividad farmacológica que la que presentan las sustancias análogas sintetizadas1(a,b). En la actualidad, se han realizados numerosos descubrimientos científicos que confirman el enorme potencial curativo que conserva el mundo vegetal. Durante investigaciones realizadas se han descubierto aplicaciones sorprendentes para muchas plantas y sustancias derivadas de éstas. Estos descubrimientos presentan nuevos retos para la humanidad. La cantidad de plantas con propiedades curativas es tal que nadie puede dominar la totalidad del conocimiento generado por su estudio. Sin embargo, no hay duda de que la ciencia y la tecnología, pueden ayudar a descubrir y utilizar las propiedades terapéuticas de las plantas medicinales de forma más efectiva

Noninfectious dermatological diseases associated with chronic exposure to mine tailings in a Peruvian district.

BACKGROUND: Mine tailings are metallic wastes which are deposited in the environment due to mining activity. Long-term exposure to these metals is harmful to human health. OBJECTIVE: To determine if chronic exposure to mine tailings constitutes a risk factor for the development of dermatological diseases in the district of San Mateo de Huanchor (Lima, Peru). METHODS: An observational case-control study was carried out in the communities of Mayoc, Daza and Tamboraque (exposed to mine tailings, case group) located in the district of San Mateo de Huanchor, and also in the communities of Choccna and Caruya (not exposed to mine tailings, control group) located in the same district. Out of 230 adults, 121 were exposed and 109 were not exposed to mine tailings and out of 135 children, 71 were exposed and 64 were not exposed to mine tailings. RESULTS: In the adult group, 71% of the exposed cases had some noninfectious dermatological disease while in the nonexposed group the frequency was 34% [P < 0.001; odds ratio (OR) 5.40; 95% confidence interval (CI) 3.02-9.68]. A statistically significant difference between groups was found for arsenical dermatitis, nonpruritic papulovesicular eruption, atopic dermatitis, contact dermatitis, seborrhoeic dermatitis and xerosis. In the paediatric population, 71 exposed and 64 nonexposed children were evaluated. Sixty-nine per cent of the exposed group had some noninfectious dermatological disease vs. 30% in the nonexposed group (P < 0.001; OR 6.00; 95% CI 2.71-13.31). A statistically significant difference between groups was found for xerosis and atopic dermatitis. CONCLUSION: Chronic exposure to mine tailings represents a risk factor for development of noninfectious dermatological diseases in both adults and children.

Abordaje integral de un paciente en una comunidad terapéutica / Integral treatment for a patient in a therapeutic community

La rehabilitación psiquiátrica hace referencia a un abordaje de tratamiento integral de aquellas personas que sufren trastornos mentales severos y persistentes que interfieren en sus capacidades funcionales de la vida diaria, como el autocuidado, las relaciones interpersonales, el trabajo o los estudios, y que a menudo precisan atención hospitalaria o tratamiento psiquiátrico prolongados. Dentro de los enfermos mentales crónicos nos vamos a centrar en los que padecen esquizofrenia, ya que tienen una elevada tasa de incidencia, que es homogénea en todas las regiones del mundo, aceptándose que el 1% de la población general de los individuos padecerá a lo largo de su vida la enfermedad en alguna de sus formas. No sólo hay que analizar la presencia de síntomas positivos en la historia evolutiva de la enfermedad, sino también el deterioro en el funcionamiento cognitivo y las limitaciones en la autonomía personal, además de la carga familiar y la tendencia a evolucionar hacia la instauración de un cuadro socialmente invalidante y de marginación social. En el campo de la rehabilitación psiquiátrica consideramos fundamentales una serie de de programas de intervención, en los que participa un equipo multidisciplinar, dirigidos a mejorar las capacidades a largo plazo de las personas con enfermedad mental crónica en lo referente a la vida, aprendizajes, trabajos, socialización y adaptación de la forma más normalizada posible

Psychiatric rehabilitation refers to a tackling of an integral treatment for those people suffering severe and persistent mental disorders that interfere their functional abilities in daily life, such as autocare, interpersonal relationships, work or studies, and often requiring hospitalization or long psychiatric treatment. Inside the group of chronic mental patients we are going to refer only to those suffering from schizophrenia, because they have a high rate of incidence, which is homogeneous all around the world; it is accepted that one percent of general population will suffer from this illness in any of its kinds during their lives. We must analyse not only the presence of positive symptoms in the evolutionary history of the disease, but also the deterioration in the cognitive functioning and the limitations to personal autonomy, as well as the family charge and the tendency to progress towards the instauration of a socially invalidating and marginal disease. Inside the psychiatric rehabilitation field we regard as essential a range of intervention schedules, with a multiprofessional team, having the purpose of improving on a long term basis the abilities of people suffering from chronic mental disease, in aspects related with life, apprenticeship, employment, socialization and adaptation in the most normalized way as possible (AU)

A protocol for the calibration of gamma cameras to estimate internal contamination in emergency situations.

The concern about accidents involving radioactive materials has led to the search of alternative methods to quickly identify and quantify radionuclides in workers and in the population. One of the options to face up an eventual demand for mass monitoring of internal contamination is the use of a nuclear medicine diagnostic equipment known as gamma camera, a device used to scan patients who have been administered specific amounts of radioactive materials for medical purposes. Although the gamma camera is used for image diagnosis, it can be calibrated with anthropomorphic phantoms or point sources for the quantification of radionuclide activities in the human body. This work presents a protocol for the calibration of gamma cameras for such application. In order to evaluate the suitability of this type of equipment, a gamma camera available in a public hospital located in Rio de Janeiro was calibrated for the in vivo measurement of 131I. The calibration includes the determination of detection efficiencies and minimum detectable activities for each radionuclide. The results show that the gamma camera presents enough sensitivity to detect activity levels corresponding to effective doses below 1 mSv. The protocol is the basis to establish a network of Nuclear Medicine Centres, located in public hospitals in eight countries of Latin America (Argentina, Brazil, Colombia, Cuba, Chile, Mexico, Peru and Uruguay) and in Spain that could be requested to collaborate in remediation actions in the event of an accident involving incorporation of radioactive materials. This protocol is one of the most significant outputs of the IAEA-ARCAL Project (RLA/9/049-LXXVIII) aimed to the Harmonization of Internal Dosimetry Procedures.